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Medicare Basics

Medicare Basics. The Parts of Medicare. Part A - Traditional Medicare Part B - Traditional Medicare Part C - Medicare Advantage (MA) Part D – Prescription Drug coverage Supplemental Medicare – also known as MediGap. 2. What does Medicare Part A Cover?. Inpatient hospital

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Medicare Basics

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  1. Medicare Basics

  2. The Parts of Medicare • Part A - Traditional Medicare • Part B - Traditional Medicare • Part C - Medicare Advantage (MA) • Part D – Prescription Drug coverage • Supplemental Medicare – also known as MediGap 2

  3. What does Medicare Part A Cover? • Inpatient hospital • Skilled nursing facility (SNF) • Home health • Hospice 3

  4. What does Medicare Part B Cover? • Medical procedures, doctors office visits, office-based testing, services and equipment • Injectable drugs administered in the doctor’s office • Outpatient services 4

  5. What does Medicare Part C or Medicare Advantage offer? • Health Maintenance Organizations (HMOs) • Require you to seek care in a specified network of hospitals and doctors • Preferred Provider Organizations (PPOs) • Allow members to obtain care from providers outside networks, at higher costs • Private Fee-for-Service (PFFS) • Waivers for those who have group health coverage through an employer or union 5

  6. How does MA differ from Traditional Medicare? Although MA plans must provide the same benefits as Traditional Medicare, there may be: • Different coinsurances, copayments or deductibles • Different regions offer different plans • Additional services such as vision care, dental care and hearing exams • Prior authorizations for certain services • Requirements to try and fail another medicine before receiving the prescribed medicine (Step Therapy) 6

  7. What is Supplemental Medicare or Medigap? • Can only be purchased with Traditional Medicare Plans and can NOT be purchased with Medicare advantage plans • Cover some or part of out-of-pocket costs related to Medicare Part B • Best time to purchase is during initial enrollment period 7

  8. What to keep in mind regarding Supplemental Medicare or Medigap • Beneficiaries enrolled in MA plans for a year may not qualify for Medigap Medigap coverage, if joining Traditional Medicare • Medigap policies must follow federal and state laws. However, Massachusetts, Minnesota, and Wisconsin Medigap policies are standardized in a different way. • Starting January 1, 2020, Medigap plans will not cover the Part B deductible. Those with Plans C and F will be “grandfathered” and able to continue with their plan. Those eligible for Medicare before January 1, 2020, but not yet enrolled, may still purchase either plan. New enrollees on or after 1/1/2020 will no longer have the option to purchase Medigap Plan C or F. • Consider “Community rated” or “Issue-age related” over “attained age” plans that have rates that increase uncontrollably 8

  9. Medigap information • Find a Medigap policy (https://www.medicare.gov/medigap-supplemental-insurance-plans/). • State Health Insurance Assistance Program (SHIP). https://www.shiptacenter.org/ • State Insurance Department.https://www.medicare.gov/Contacts/ 9

  10. Medicare Enrollment • Initial enrollment • Open Enrollment • Medigap Medicare Enrollment • Part D sign up • Late enrollees may incur a penalty for not signing up for Part A, Part B and Part D when first eligible. 10

  11. When can beneficiaries sign up for Medicare? • For initial enrollment, beneficiaries have 7 months spanning 3 months before their birthday, their birthday month and 3 months after their birthday to sign up for Traditional Medicare or Medicare Advantage. • Medicare Open Enrollment is October 15 – December 7 every year. • From October 15 through December 7, Medicare beneficiaries can join, switch, or drop a Medicare Advantage Plan. • Individuals receiving Social Security or Railroad Retirement Board benefits, are automatically enrolled the first day of the month they turn 65. • Medicare Supplemental or Medigap policies can be purchased during the 6-month Medigap open enrollment period. • Part D sign up is within 3 months of receiving Medicare Part A or B, or there is a late-enrollment penalty. 11

  12. When is Medicare Advantage Open Enrollment? • January 1 – March 31 • If beneficiaries are in a MA plan, they can switch to another MA plan • Beneficiaries can return to Traditional Medicare during this period, however, if the beneficiary re-enrolls in Traditional Medicare they may not be able to re-enroll in Medigap Medicare. • Traditional Medicare Beneficiaries can not switch plans 12

  13. Differences between Traditional Medicare and MA • Access • Coverage • Costs 13

  14. Access compared 14

  15. Coverage compared 15

  16. Costs compared 16

  17. Considerations for beneficiaries during enrollment • List your providers. Do all of my doctors, hospitals, surgical centers, etc. accept my coverage? • List your drugs. Are my medications covered by the plan I am considering? • Do I travel to other parts of the country for extended periods of time? Will I be able to see a doctor in those places? • Have I talked to my physicians and pharmacists about the plan I am considering? • Are there out-of-pocket costs for office visits, testing, procedures and/or drugs? • Does my insurer have rules for physician administered drugs, such as my eye injections for Eylea or Lucentis? 17

  18. For more information • Medicare & You handbook • https://www.medicare.gov/medicare-and-you • 1-800-MEDICARE (1-800-633-4227) • https://www.medicare.gov/forms-help-resources/contact-medicare • Centers for Medicare & Medicaid Services (CMS) • https://www.cms.gov/ • Medicare.gov • https://www.medicare.gov/ • 2019 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare • https://www.medicare.gov/pubs/pdf/02110-medicare-medigap-guide.pdf • MyMedicare.gov • https://www.mymedicare.gov/ 18

  19. Resources Medicare and You Handbook https://www.medicare.gov/sites/default/files/2019-09/10050-medicare-and-you.pdf 1-800-MEDICARE (1-800-633-4227) TTY users can call 1-877-486-2048. Glossary of Health Coverage and Medical Terms https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/UG-Glossary-508-MM.pdf The Medicare Resource Center https://www.medicareresources.org Medicare Plan finderwww.medicare.gov/find-a-plan Medicare Rights Getting Medicare Right https://www.medicarerights.org/fliers/Medicare-Advantage/Differences-Between-OM-and-MA.pdf?nrd=1 Kaiser Health News Medicare vs. Medicare Advantage How to Choose https://khn.org/news/medicare-vs-medicare-advantage-how-to-choose/ 19

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